Background: Morphea is an autoimmune inflammatory connective tissue disease that may cause permanent functional disability and disfigurement. Histopathological features in morphea (localized scleroderma) and their clinical correlated characteristics are poorly described. Objectives: To describe the clinical characteristics, treatment regimens, and histopathological features of all patients diagnosed with morphea, and determine the association between histopathology and clinical factors. Methods: A single center, retrospective, descriptive, and analytical study of 137 patients with skin biopsy-proven morphea between January 2008 and March 2019. Results: Of the 137 patients (median age at diagnosis, 34.5 years), 112 (81.8%) were female, linear (45.3%) and plaque (43.1%) morphea were most common. Functional limitations or subjective symptoms were reported in 36 (26.3%) subjects, and 40 (29.2%) patients showed ≥1 abnormal laboratory finding. 46 (33.6%) patients received systemic treatment including corticosteroids, methotrexate, and hydroxychloroquine. Poor clinical outcome was reported in 31 (22.6%) patients, which was significantly associated with recent spreading, functional limitations or subjective symptoms, and ≥1 abnormal laboratory finding. Conclusion: Histopathological examination of morphea and clinical correlation can assist in identifying patients with clinical and pathological features related to poor clinical outcomes, which may require additional monitoring and agressive treatment